Sylvia Tara - The Secret Life of Fat

The Science Behind the Bodys Least Understood Organ
and What It Means for You

THE

SECRET LIFE OF

FAT

Sylvia Tara, PhD

W. W. NORTON & COMPANY

Independent Publishers Since 1923

New York London

The Secret Life of Fat is a work of nonfiction. With the exception of those whose stories have been reported elsewhere, or who have agreed to be identified here, the individuals whose struggles appear in these pages are referred to by aliases, and some of their identifying characteristics have been changed. Where my own story is concerned, I ask the reader to bear in mind that my approach is not for everyone. No book can replace the expertise of a trained professional who has examined you and is familiar with your medical history. Please be certain to consult with your physician before making changes to your current food or exercise regimen, particularly if you are pregnant, suffer from any medical condition, or have any symptoms that may require treatment.

Dedicated to my parents

Copyright 2017 by Sylvia Tara

All rights reserved
First Edition

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The Library of Congress has cataloged the printed edition as follows:

Names: Tara, Sylvia.
Title: The secret life of fat : the science behind the bodys least understood
organ and what it means for you / Sylvia Tara, PhD.
Description: First edition. | New York : W.W. Norton & Company, [2017] |
Includes bibliographical references and index.
Identifiers: LCCN 2016027841 | ISBN 9780393244830 (hardcover)
Subjects: LCSH: Fat. | FatHealth aspects.
Classification: LCC QP752.F3 T37 2017 | DDC 613.2dc23 LC record
available at https://lccn.loc.gov/2016027841

ISBN 978-0-393-24484-7 (e-book)

W. W. Norton & Company, Inc.
500 Fifth Avenue, New York, N.Y. 10110
www.wwnorton.com

W. W. Norton & Company Ltd.
15 Carlisle Street, London W1D 3BS

The Secret Life of Fat is a work of nonfiction. With the exception of those whose stories have been reported elsewhere, or who have agreed to be identified here, the individuals whose struggles appear in these pages are referred to by aliases, and some of their identifying characteristics have been changed. Where my own story is concerned, I ask the reader to bear in mind that my approach is not for everyone. No book can replace the expertise of a trained professional who has examined you and is familiar with your medical history. Please be certain to consult with your physician before making changes to your current food or exercise regimen, particularly if you are pregnant, suffer from any medical condition, or have any symptoms that may require treatment.

THE SECRET LIFE OF
FAT

S o what is fat exactly? We all agree that fat, in its simplest form, is a reserve of energy, perhaps a relic from our nomadic ancestors who needed it to protect against frequent famine. But now that there are supermarkets and fast-food chains on every corner, fat seems to be a biological anachronism. Even the dictionary definition of fata natural oily or greasy substance occurring in animal bodies, especially when deposited as a layer under the skin or around certain organsreinforces the idea that it is not particularly important to us.

Not reflected in the common understanding, however, is the vast importance fat has in our lives. From managing our energy stores, to enabling transmission of brain signals, to facilitating labor in pregnacy, fat has shown itself to be a critical and versatile body part. Although fat was once thought of as inert blubber, researchers now categorize it as an organ. If you doubt the importance of fat, imagine what would happen if you didnt have any. To get an idea of what life would be like, look no further than the story of Christina Vena.

The Girl with No Fat

C hristina was a healthy, vibrant twelve-year-old living in Vineland, New Jersey, in the 1990s. Her days were filled with school, sports, friends, and a newly developing interest in boys. But just as Christina entered puberty, something strange happened. Her body spontaneously began losing fat. Many twelve-year-old girls would rejoice at being a bit skinnier, but Christinas case was worrisome. She lost the fat in her cheeks, hands, and feet. Her looks changed rapidly as her face became sunken and her hands shriveled. Soon, Christina started to lose fat on the rest of her body as well, and her clothes hung off her shrinking frame.

Oddly, at the same time she developed an enormous appetite. She remembers, I was very hungry. I was hungry to the point where I wouldnt know I was full until I got sick. I ate all of the time, I couldnt stop. Despite all her eating, Christina just kept getting thinner.

Her parents believed she was going through the normal growth spurt of an early teenager. Nothing to worry about, they thought, so they let her eat as much as she wanted. Some of her friends even envied how much Christina could eat and yet stay so thin. But she continued losing fat, and eventually she lost so much that her face became unrecognizable to people who knew her in the past.

It was an unusual pairingheavy eating coupled with dramatic fat loss. And soon, another strange event took placebumps started forming on Christinas arms. At first there were just a few soft lumps on her forearms. But eventually, dozens of soft, fluid-filled bumps appeared and wouldnt go away. Her parents grew concerned. They took her to a dermatologist, who ordered blood tests.

The results of the tests were shocking. Christinas total cholesterol was 950 mg/dL, though the normal level for a girl her age is under 170. Her triglycerides, which should have been around 150 mg/dL, measured 16,000. Postmeal blood sugar would normally be 100 mg/dL. Instead, hers was 500. Her blood was literally full of fat, cholesterol, and sugar.

Once Christinas dermatologist reviewed the test results he recognized that this was not a dermatology issue but a metabolic one. He immediately referred Christina to an endocrinologist at the Childrens Hospital of Philadelphia.

At first, her endocrinologist thought she had diabetes and started treating her for that. But Christinas health didnt improve. Even as she took her diabetes medicine, her weight continued to drop and her appetite grew. Christina recalls, I actually would eat anything in the house. It didnt have to be something that tasted great. I would eat anything I could get my hands on, like a can of mushrooms. It was out of control. My parents used to lock the pantry. They put locks on everything, and I would sit there and cry.

The bumps on Christinas arms started spreading. Now they appeared everywhere, from the tips of her toes to her shoulders. Not only were they unsightly, they were inflamed and extremely painful. She says, If you just touched the bumps, it hurt. And of course, they showed up on all of my pressure points, so I couldnt walk. I had a hard time bathing myself. I had a hard time eating and holding silverware. I had to have special silverware to eat. Just moving in general was starting to be too much.

Her endocrinologist was stumped, until he remembered having heard a lecture given by Dr. Elif Oral at the National Institutes of Health in Bethesda, Maryland. Oral was a specialist in endocrine diseases, diabetes, and metabolic disorders, and was studying patients with symptoms similar to Christinas. The endocrinologist sent Christina to Dr. Oral, who examined her in March 1997.